New York State Comptroller Thomas P. DiNapoli today announced that the following State Government Accountability audits have been released.

Department of Health – Medicaid Program: Claims Processing Activity April 1, 2025 Through September 30, 2025 (2025-S-11)

During the 6-month period ended September 30, 2025, the Department of Health’s (DOH) claims processing system, eMedNY, processed almost 331 million claims, resulting in payments to providers of nearly $55 billion. Auditors identified over $12.1 million in improper Medicaid payments. As a result of the audit, nearly $3.4 million of the improper payments was recovered. The audit also identified 14 Medicaid providers who were charged with or found guilty of crimes that violated laws or regulations governing certain health care programs. In response to the findings, DOH removed 12 providers from the Medicaid program; one of the remaining two providers was referred to the New York State Education Department’s Office of Professions, and the other provider was referred to DOH’s Office of Professional Medical Conduct.

Metropolitan Transportation Authority – Long Island Rail Road: Mitigation for Extreme Weather Conditions and Flooding (Follow-Up) (2025-F-30)

In April 2009, the Metropolitan Transportation Authority (MTA)-established Blue-Ribbon Commission on Sustainability released its Final Report, which predicted that, without an adequate investment in adaptation measures, climate change would have even greater adverse impacts on the MTA’s vital infrastructure, operations, and revenue streams in the future. The report recommended that the MTA have a climate change adaptation master plan in place by 2015. A prior audit, issued in March 2024, found the Long Island Rail Road (LIRR) did not perform a systemwide assessment of its transportation facilities to identify weather-related risks and that LIRR departments either were not in compliance with or did not provide documentation to support compliance with storm operating plans. MTA-LIRR officials made some progress in addressing the problems identified in the initial audit report. Of the initial report’s 12 audit recommendations, five were implemented, four were partially implemented, and three were not implemented.

Empire State Development: Real Property Portfolio (Follow-Up) (2025-F-33)

Empire State Development (ESD) invests in infrastructure and innovation, provides early-stage support for new ventures, and strengthens the State’s innovation-based economy through partnerships with universities. A prior audit, issued in August 2024, found ESD did not comply with requirements to publish a report detailing its real property portfolio; as of June 2023, ESD reported it owned 130 properties—of those, 71 (55%) were vacant; and ESD disposed of 10 properties at below-market value between April 2019 and May 2023. While each of the 10 disposals was completed in compliance with requirements, the below-market transfers for seven properties did not include sufficient information about the anticipated economic benefits of the projects compared to the value received and the fair market value of the properties. ESD made significant progress in addressing the problems identified in the initial audit report, implementing two recommendations and partially implementing one.

Department of Civil Service – New York State Health Insurance Program: CVS Caremark Payments Made Under the Incorrect Plan (2025-S-19)

The Department of Civil Service contracts with CaremarkPCS Health, L.L.C. (CVS Caremark) to administer the prescription drug program for the Empire Plan, the primary health benefits plan for the New York State Health Insurance Program. This program includes the Empire Plan Medicare Rx drug plan for retired members who have Medicare and their dependents, and a Commercial Plan for non-Medicare-qualified members and their dependents. Claims paid under the Medicare Rx Plan are eligible for drug manufacturer discounts and federal subsidies that are not available for claims paid under the Commercial Plan. Accordingly, ensuring that claims are properly paid under the Medicare Rx Plan allows for significant cost avoidance for the State. The audit identified $19.3 million in claims for 338 Medicare-qualified members and their dependents that were incorrectly paid under the Commercial Plan instead of the Medicare Rx Plan.

Department of Health – Medicaid Program: Oversight of Clinical Trials (2024-S-22)

Clinical trials are research studies that evaluate the safety and effectiveness of medical care. New York’s Medicaid program generally does not cover investigational items or services that are the subject of the clinical trial, nor does it cover services provided solely for data collection, but does cover the routine costs of items or services that are necessary for clinical trial participants and are typically covered outside of the trial under the state plan or waiver. In addition to verifying a member’s Medicaid status, a coverage determination must be based on an attestation of the appropriateness of the clinical trial by both the principal investigator and the health care provider responsible for the trial. The audit found that the Department of Health did not always receive an attestation form before members participated in a clinical trial, as required. Additionally, it identified a limited number of improper Medicaid payments for services that were the responsibility of the clinical trial sponsor, investigational services not covered by the member’s managed care organization, or services that lacked supporting prior authorization.